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PrEp and Unprotected Sex?

Aug 14, 2017

Hello, about a week ago I had unprotected anal sex with a guy. I'm on PrEp and so is he, assuming he's telling me the truth. I'm getting worried because I have a little bit of a sore throat and my lymphnodes feel swollen. I take my truvada pill everyday but I'm still worried about contracting hiv. Should I worry? I plan on taking an hiv test at the three week mark. I did email my physician and he told me that I should be fine and to continue on my medication. I'm feeling anxious and depressed, and it's hard to sleep. Your take and advice on the matter will be great.

Response from Mr. Jacobs

I can understand your concerns. On one hand, we have been told for the better part of three decades that condomless sex is immoral, dangerous, and possibly fatal. On the other hand, we now know that consistent use of PrEP reduces risk of acquiring HIV by greater than 99% (http://www.natap.org/2016/ICAAC/ICAAC_02.htm). So how do we make sexual decisions based on all this conflicting data?

First, we get the facts. No one in the initial PrEP research trials, nor 32 clinical demonstration projects, acquired HIV when they took PrEP as directed (https://www.hiveonline.org/bob-grant-and-damon-jacobs-talk-prep/). In order to participate in one of these studies, one had to be acute risk of acquiring HIV, which in most cases meant having condomless sex with one or more partners. That means that consistent use of PrEP is "protected" sex, it is protecting at least 200,000 consumers as we speak. So if you are using PrEP as your doctor prescribed, you indeed had "protected" anal sex with your partner, even if condoms were not used.

One of the advantages of PrEP is that your partner need not also be using PrEP for you to be protected. PrEP is the first prevention option that puts the individual in complete control of their own health (whereas condoms involve some sort of negotiation, agreement, and follow through on behalf of the top). So whether or not your partner was using PrEP or not is statistically inconsequential, you are still protected whether he was using PrEP or not.

I can't tell you what you "should" feel, as there are no "shoulds" about emotions. But I can recommend you consider the science and facts as you make your emotional decisions. Believe me, I get that unlearning 30+ years of sexual fear is a difficult task. Many of the group members over at the Facebook "PrEP Facts" group share these struggles on a regular basis (https://www.facebook.com/groups/PrEPFacts/). I shared my own personal journey with unlearning oppressive fears while using PrEP here at the The Body.com: http://www.thebody.com/content/77188/the-persistence-of-hiv-fear-in-the-age-of-prep.html

Your doctor was correct and accurate in trying to assuage your worries. You were using PrEP exactly for what is indicated for. Hopefully, once this and future HIV tests result as negative you will be able to relax and enjoy sexual intimacy for all the physical and emotional pleasures it can offer.

For more information about PrEP, science, and personal experiences with intimacy and pleasure, please feel free to join the international "PrEP Facts" Facebook group at https://www.facebook.com/groups/PrEPFacts/. Enjoy!



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